Southport Surgical Associates, P.a.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

9400669 Issued in NC

Legal business name

SOUTHPORT SURGICAL ASSOCIATES, P.A.

Practice address

621B N Fodale Ave
Southport, NC 28461-3550

Phone

(910) 457-1880

NPI assigned

May 24, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Larry Felix Weisner

Title

President

Phone

(910) 457-1880

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760693618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621B N FODALE AVE",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284613550",
            "telephone_number": "910-457-1880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621B N FODALE AVE",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284613550",
            "telephone_number": "910-457-1880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPORT SURGICAL ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WEISNER",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "FELIX",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-457-1880",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "NC",
            "license": "9400669",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790156Q",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Cross
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• Southport Eye Care OD PLLC
• Southport Internal Medicine PA
• Southport Pulmonary Medicine, PLLC
• Southport Urgent Care
• Southport Urgent Care PLLS
• Christine Louise Sparks, O.T.
• Brittany Killian Spears, PT, DPT
• St. James Fire Department, Inc.

• Surgery Physician in Southport, NC
• Providers in Southport, NC by specialty
• Surgery Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.